title: Impact of aortic valve calcification severity and impaired left ventricular function on 3-year results of patients undergoing transcatheter aortic valve replacement.
abstract: OBJECTIVE
  To evaluate clinical pre-interventional predictors of 3-year outcome and mortality in high-risk patients with severe aortic valve stenosis treated with transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Among 367 patients included in the Aachen TAVI registry, 76 patients with baseline dual-source computed tomography (DSCT) for the quantification of aortic valve calcification (AVC) and a 3-year follow-up were identified.
  
  
  RESULTS
  Survival at 30 days was 91 %, and it was 75 %, 66 % and 64 % at 1, 2 years and 3 years, respectively. Non-survivors at 3 years showed a significantly higher Agatston AVC score (2,854 ± 1,651) than survivors (1,854 ± 961, P = 0.007). Multivariate analysis including age, logistic EuroScore, glomerular filtration rate, Agatston AVC score, ejection fraction < 40 %, NYHA class, baseline medication, chronic lung disease and aortic regurgitation revealed that only the Agatston AVC score (P = 0.03) and impaired left ventricular function (P = 0.001) was significantly associated with mortality. Patients with Agatston AVC scores >2,000 had a significantly lower 3-year survival rate compared with patients with scores <2,000 (47 % vs 79 %, P = 0.004).
  
  
  CONCLUSIONS
  In patients referred for TAVI, aortic valve calcification severity and impaired left ventricular function may serve as a predictor of long-term mortality. Therefore, AVC scores easily determined from pre-procedural CT datasets may be used for patient risk stratification.
authors.affiliation: Department of Cardiology, University Hospital RWTH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany, rkoos@ukaachen.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Koos
authors.forename: Sebastian
authors.initials: S
authors.lastname: Reinartz
authors.forename: Andreas Horst
authors.initials: AH
authors.lastname: Mahnken
authors.forename: Ralf
authors.initials: R
authors.lastname: Herpertz
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfi
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002114:Calcinosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*